OUTCOME OF PROTEIN-ENERGY MALNUTRITION IN ELDERLY MEDICAL PATIENTS

PURPOSE: TO assess the impact of protein-energy malnutrition (PEM) on mortality and the long-term variations in the nutritional status of su bjects admitted as emergency cases in a 9-month prospective follow-up study. PATIENTS AND METHODS: The study comprised 205 patients without cancer aged 75 years (+/- 1). Malnourished subjects were identified as having at least three nutritional variables (which included weight in dex, triceps skinfold thickness, arm muscle circumference, serum album in, acid delayed cutaneous hypersensitivity reaction) below the refere nce range. RESULTS: The mortality was 44% in the 41 malnourished patie nts and 18% in the 164 nonmalnourished subjects (P <0.001). Among maln ourished patients with congestive heart failure the mortality was 80%. Multivariate analysis revealed congestive heart failure, multiple org an disease, and PEM to be predictors of death. When the interaction be tween these disorders and PEM was considered, the prognostic relevance of PEM remained among the patients with cardiac congestion. Of the su rviving subjects, 125 were reexamined after 9 months. At admission, mo re than half of the patients had displayed elevated revels of serum ac id glycoprotein as evidence of an ongoing inflammation and subnormal r ecordings for serum albumin and delayed cutaneous hypersensitivity At the reexamination, these variables had normalized in the well-nourishe d patients and in the 9 patients who had recovered from PEM, but remai ned unchanged in the 10 patients with persistent PEM. The latter patie nts were severely malnourished, commonly infected, and often hospitali zed. CONCLUSIONS: Protein-energy malnutrition in noncancer medical pat ients is associated with an excess mortality in those with congestive heart failure. Improvement of PEM is accompanied by a decline in infla mmatory activity.